Adam J. Singer, Henry C. Thode Jr., Stuart Chale, Breena R. Taira, Christopher Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.004
Published online: March 29 2010
xCutaneous abscesses have traditionally been treated with incision and drainage followed by secondary healing. Primary closure after incision and drainage is an alternative mode of therapy practiced in some parts of the world. The current study reviews the experience with primary closure of abscesses.
Nitin D. Ubhayakar, Christopher J. Lindsell, Dana L. Raab, Andrew H. Ruffner, Alexander T. Trott, Carl J. Fichtenbaum, Michael S. Lyons
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.005
Published online: March 26 2010
xScreening for HIV in the emergency department (ED) is recommended by the Centers for Disease Control and Prevention. The relative importance of efforts to increase consent among those who currently decline screening is not well understood. We compared the risk characteristics reported by patients who decline risk-targeted, opt-in ED screening with those who consent. We secondarily recorded reasons for declining testing and reversal of the decision to decline testing after prevention counseling. Of 199 eligible patients, 106 consented to testing and 93 declined.
Stephen W. Borron, Juan C. Arias, Charles R. Bauer, Thomas Philbeck, Patti Hass, Wayne Lawson, Diana Montez, Miguel Fernández, Inkyung Jung, Donald J. Gordon
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.009
Published online: April 5 2010
xEarly antidotal therapy may be lifesaving in hazardous materials victims. Intravenous line placement is difficult while wearing personal protective equipment (PPE). We assessed the ability of protected, experienced first responders and limited-experience first receivers to place intraosseous (IO) lines for antidote administration.
Gregory W. Hendey, Robert A. Dery, Randy L. Barnes, Brandy Snowden, Philippe Mentler
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.010
Published online: March 26 2010
xThe aim of this study was to compare phenobarbital (PB) versus lorazepam (LZ) in the treatment of alcohol withdrawal in the emergency department (ED) and at 48 hours.
Ofir Uri, Lior Yosefov, Amir Haim, Eyal Behrbalk, Pinchas Halpern
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.011
Published online: March 26 2010
xThe aim of the study was to evaluate the efficacy of topical 2% lidocaine gel in reducing pain and discomfort associated with nasogastric tube insertion (NGTI) and compare lidocaine to ordinary lubricant gel in the ease in carrying out the procedure.
Opeolu Adeoye, Mary Haverbusch, Daniel Woo, Padmini Sekar, Charles J. Moomaw, Dawn Kleindorfer, Brian Stettler, Brett M. Kissela, Joseph P. Broderick, Matthew L. Flaherty
DOI: http://dx.doi.org/10.1016/j.ajem.2009.10.016
Published online: March 26 2010
xEarly deterioration is common in intracerebral hemorrhage (ICH). Treatment at tertiary care centers has been associated with lower ICH mortality. Guidelines recommend aggressive care for 24 hours irrespective of the initial outlook. We examined the frequency of and factors associated with transfer to tertiary centers in ICH patients who initially presented at nontertiary emergency departments (EDs). We also compared observed with expected mortality in transferred and nontransferred patients using published short-term mortality predictors for ICH.
Haroon Chughtai, Douglas Ratner, Mario Pozo, Joseph A. Crouchman, Barbara Niedz, Richard Merwin, Robert G. Lahita
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.006
Published online: April 5 2010
xWe performed this study to assess the impact of pre-hospital time on the patient’s outcome.
Arvind Venkat, Rene B. Pastin, Gajanan G. Hegde, John M. Shea, Jeffrey T. Cook, Carl Culig
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.009
Published online: April 26 2010
xWe sought to identify factors increasing the odds of ED utilization among intellectually disabled (ID) adults and differentiate their discharge diagnoses from the general adult ED population.
Kyung Su Kim, Kyuseok Kim, Seung Sik Hwang, You Hwan Jo, Christopher C. Lee, Tae Yun Kim, Joong Eui Rhee, Gil Joon Suh, Adam J. Singer, Hye Duk Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.015
Published online: April 5 2010
xAbdominal contrast-enhanced computed tomography (A-CECT) is widely used in emergency departments despite the risk of contrast-induced nephropathy. We attempted to develop a risk stratification nomogram for nephropathy in patients receiving emergency A-CECT.
Jennifer C. Chen, Matthew Bidwell Goetz, Jamie E. Feld, Anne Taylor, Henry Anaya, Jane Burgess, Richard de Mesa Flores, Risha A. Gidwani, Herschel Knapp, Elizabeth H. Ocampo, Steven M. Asch
DOI: http://dx.doi.org/10.1016/j.ajem.2009.11.016
Published online: April 5 2010
xThe Centers for Disease Control and Prevention recommends routine HIV screening for adults.
Brittany A. Zwischenberger, Billy J. Moore, Samuel D. Luber, Florence J. Dallo
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.001
Published online: April 28 2010
xEmergency department (ED) chest pain protocols often include an exercise stress test (EST) in an outpatient setting to further risk stratify patients initially identified as low risk for acute coronary syndrome. Our goal was to characterize the noncompliant patient population and delineate reasons for uncompleted EST.
James H. Moak, Michael S. Lyons, Stewart W. Wright, Christopher J. Lindsell
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.004
Published online: April 14 2010
xReimbursement for ultrasound-guided central lines requires documenting the needle entering the vessel lumen. We hypothesized that physicians often successfully perform ultrasound-guided internal jugular (IJ) cannulation without visualizing the needle in the lumen and that guidewire visualization occurs more frequently.
Howard A. Werman, Robert Newland, Brad Cotton
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.015
Published online: May 5 2010
xPrehospital transmission of the electrocardiogram (ECG) in ST-elevation myocardial infarction patients has been shown to reduce door to treatment time and improve outcome. Acquisition of the ECG tracing is a paramedic skill, thus limiting the benefit of early ECG transmission to primarily urban areas. The purpose of this investigation was to determine whether prehospital ECGs could be transmitted by nonparamedic personnel.
Kimberly R. Smith, Charles K. Brown, Kori L. Brewer
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.001
Published online: March 30 2011
xAlmost every patient who comes to an emergency department (ED) with the chief complaint of ankle or foot pain will receive a radiograph, but less than 15% will have a finding positive for ankle or midfoot fracture. In an effort to reduce the number of radiographs performed, clinicians have attempted to derive a set of maximally sensitive clinical prediction rules. Dayan et al (Acad Emerg Med. 2004;11(7):736-745) in 2004 derived a set of such rules for children. These rules have not yet been evaluated in the adult population.
J. Douglas Kirk, Michael Kontos, Deborah B. Diercks
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.023
Published online: May 3 2010
xRapid risk stratification, selection of downstream management options, and institution of initial pharmacotherapy are essential to ensure that patients admitted to the emergency department with acute coronary syndromes receive optimal care. A broad range of antiplatelet and antithrombotic medications is available that permits tailoring of initial pharmacotherapy to each patient's risk status. In the urgent setting, thienopyridines (clopidogrel and prasugrel) carry limitations including response variability and increased risk for bleeding in patients requiring subsequent coronary artery bypass graft surgery.
Hsing-Lin Lin, Tsung-Ying Lin, Wei-Che Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.008
Published online: January 5 2011
xWe read the article “Human cytokine response to Texas crotaline envenomation before and after antivenom administration� written by Crocker et al [1] with great interest. They found that crotaline venom produces a broad cytokine response in human bite victims with several identified markers that might lead to improved therapies and better prognostic indicators. We hope that this may provide new diagnostic tools to identify unknown snakebites. In the emergency department in Taiwan, the biggest challenge for the physician is dealing with a patient bitten by an unknown venomous snake.
Antone Eason, Vytautas Vaicys, Erik Kulstad
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.023
Published online: January 5 2011
xThe problem of emergency department (ED) crowding continues to plague health care systems around the world [1]. Although various metrics have been proposed for the quantification of ED crowding, the acquisition of data required for these metrics at regular intervals, such as the total number of patients in the ED, total beds available, and ED diversion status, typically requires skilled data mining and tedious data entry that is inherently error prone and void of real-time analysis. Moreover, many emergency medical record (EMR) tracking boards do not archive these key metrics, thus further complicating research and analysis of ED crowding.
Eleni Palli, Demosthenes Makris, Chrysi Diakaki, Grigorios Garoufalis, Epaminondas Zakynthinos
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.002
Published online: February 7 2011
xGlyphosate surfactant (GlySH)—an agricultural chemical agent, herbicide—has been used for suicide attempts [1]. Intoxication by GlySH may involve many organs and systems such as the lungs, the kidneys, the liver, and the cardiovascular and nervous systems and, in some cases, may be fatal [2,3]. In contrast, gastrointestinal disorders associated with GlySH intoxication are considered to be moderate, usually limited to local irritation and dysphagia, mainly of the upper tract. We, therefore, wish to report a case of intoxication with a commercial herbicide agent containing GlySH, which apart from the usual multiorgan failure was also associated with extensive corrosive injuries of the large intestine.
Goran P. Koracevic
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.007
Published online: January 27 2011
xCurrent guidelines for treating patients with pulmonary embolism (PE) recommend both parenteral and oral anticoagulants (OAC) from the first day, at least 5 days, and until international normalized ratio 2-3 is reached in 2 consecutive days [1,2]. This protocol is clear and easy to follow. Anticoagulant treatment plays a pivotal role in the management of patients with PE [1]. The necessity for results goes with this pivotal role. However, results in PE treatment are far from satisfactory [3]. The disappointing results should lead to prompt, critical analysis of each step in therapy.
Gen-Min Lin, Yi-Hwei Li, Chih-Lu Han
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.018
Published online: January 27 2011
xWe appreciate the work by Drs Cheng and Yen, which demonstrated that patients ranked in the higher Killip classes had higher glucose levels than those ranked in the lower classes [1]. We notice that the authors used the Mantel-Haenszel χ2 for trend and 1-way analysis of variance tests to analyze their data. However, if the 95% confidence intervals of glucose levels (mg/dL) for each Killip classes are calculated, we could obtain the following results: (173-201) for Killip class I, (168-224) for Killip class II, (166-268) for Killip class III, and (203-269) for Killip class IV.
Hsien Hung Cheng
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.019
Published online: February 28 2011
xWe are very pleased that people are interested in our study [1]. Although the 1-way analysis of variance tests showed that blood glucose levels are significantly different among Killip classes, there was no sufficient evidence to differentiate the glucose levels between each Killip class by the width of the 95% confidence interval. This resulted from a limited number of patients in our study. The proportion of diabetes in each Killip classes was the following: 31.9% for Killip class I, 33.3% for Killip class II, 34.8% for Killip class III, and 49.0% for Killip class IV.
Yona Lunsky, Elizabeth Lin, Rob Balogh, Julie Klein-Geltink, Jennifer Bennie, Andrew S. Wilton, Paul Kurdyak
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.028
Published online: February 14 2011
xThis brief report presents the first North American population data on rates of emergency department (ED) use among adults with intellectual and developmental disabilities (IDD) relative to the general population. Individuals with IDD are at greater risk for health problems compared with the general population [1,2] and have higher morbidity and earlier mortality as a result. Illness in individuals with IDD can be further exacerbated in a health care system that is fragmented and inadequately resourced, particularly when medical professionals do not have the necessary expertise [3].
Jianming Liang, Michael B. Gotway, Demetri Terzopoulos, H. Dirk Sostman
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.030
Published online: February 28 2011
xWe read with great interest the article by Costantino et al [1] and their response [2] to the correspondence by Chartrand-Lefebvre [3] regarding interobserver agreement in the interpretation of computed tomography (CT) pulmonary angiography (CTPA) for the diagnosis of acute pulmonary embolism (PE). The interobserver agreement among radiologists is high for the diagnosis of massive (ie, large central) PE but is diminished for the diagnosis of segmental and subsegmental PEs. A similar hierarchy of agreement has been demonstrated for conventional pulmonary angiography [4,5].
Alex Smithson
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.034
Published online: February 28 2011
xI have read, with interest, the article by Khawcharoenporn et al [1] in which the authors evaluate the antimicrobial resistance rates among uropathogens isolated from patients with urinary tract infection (UTI) who attended an emergency department. In my opinion, the most interesting aspect of this study is that the authors evaluate the causal microorganisms and the antimicrobial pattern found in patients with community-acquired (CoA) UTI and the ones found in patients with a health care–associated (HA) UTI.
Thana Khawcharoenporn, Shawn Vasoo, Edward Ward, Kamaljit Singh
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.036
Published online: February 28 2011
xWe thank Dr. Smithson for comments on our article [1] regarding the definition of healthcare-associated (HA) urinary tract infection (UTI) used in our study. We agree with Dr. Smithson that there is no clear consensus definition of HA-UTI. However, as previously described by a number of authors [2,3], healthcare-associated infections (HAIs) are important to differentiate from community-associated infections (CAIs) because they are often due to different and more resistant organisms. Additionally, in studies of patients with UTI, healthcare exposure has been shown to be a significant risk factor for drug resistant infections [4,5].
Giuseppe Lippi, Rosalia Aloe, Gianfranco Cervellin
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.004
Published online: February 28 2011
xWe read with interest the recent article of Birkhahn et al [1] who evaluated the use of point-of-care (POC) testing of cardiac biomarkers against standard core laboratory testing to determine the local time savings and estimate a cost-benefit ratio. It was concluded that the rapid acute cardiac evaluation pathway would have saved an overall 390 minutes (6.5 hours) in the diagnostic workup, which result from both the earlier diagnosis allowed by the POC multimarker approach (2.5 hours) and the delay in bringing the test from the laboratory to the bedside (4.0 hours).
Maria Kosmidou, Haralampos J. Milionis, Sotirios Giannopoulos
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.006
Published online: February 28 2011
xWe read with great interest the work by Youn et al [1] indicating that higher highly selective C-reactive protein (CRP) (hs-CRP) levels were associated with larger infarct volumes in acute ischemic stroke. Authors suggest that elevated hs-CRP levels reflect a large volume of infarct and may serve as a helpful biomarker in the evaluation of extent of acute ischemic stroke and the degree of systemic inflammation. It is worth to mention that den Hertog et al [2], in a large-scale evidenced study, has shown that CRP values of 7 mg/L or higher obtained within 12 hours of the onset of an acute ischemic stroke are associated with a poor outcome or death at 3 months.
Jennie Buchanan, Maria Moreira, Kennon Heard
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.015
Published online: March 30 2011
xWe thank the authors for their interest in our recent article. The authors question our recommendation of a 6-hour observation based on the potential for delayed complications and cite 2 reports [1,2]. In the Sporer study, all patients had seizures within 2 hours of observation, whereas in Pollack's series, 1 case had delayed seizures but would have been admitted and observed based on our protocol [1,2]. Although we agree that some patients may have complications after the observation period, we feel that medical decisions should be based on systematic data rather than anecdote.
Jonathan J. Marti, Joaquin F. Zalacain, Debra E. Houry, Alexander P. Isakov
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.016
Published online: August 5 2010
xNeck pain and stiffness is a common emergency department (ED) presentation and normal daily activities are usually the inciting cause. Most neck pain cases are benign in nature and can be relieved with rest and mild analgesics. Traumatic events and falls can cause severe neck injuries such as fractures, subluxation, vascular injuries, or paralysis. The following is an unusual case of atlantoaxial rotatory subluxation seen in our ED that initially presented as benign neck pain and torticollis.
Valentina Valenti, Amisha J. Patel, Sebastiano Sciarretta, Hassan Kandil, Fabrizio Bettini, Andrea Ballotta
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.017
Published online: August 5 2010
xIn 50% of acute left ventricular inferior-posterior wall myocardial infarction (MI), concomitant right ventricular MI (RVMI) has been reported, with a dramatic increased rate of mortality. We report the case of a woman with RVMI complicated by cardiogenic shock due to dissection of the right coronary artery. She was treated with liquid infusion, epinephrine, milrinone, and an intraaortic balloon pump, but clinical condition decreased. She was then intubated, and prolonged inhalation of nitric oxide (12-15 ppm) was added.
Carlos Beaumont-Caminos, Clint Jean-Louis, Tomás Belzunegui-Otano, Bernabé Fenández-Esain, Javier MartÃnez-Jarauta, José L. GarcÃa-Sanchotena
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.019
Published online: August 5 2010
xWe report the case of a 75-year-old man with an infrarenal abdominal aortic aneurysm who presented to the ED complaining of flank pain. An urgent abdominal computed tomography showed the presence of abdominal aortic aneurysm and of perirenal and retroperitoneal hemorrhage independent of the aneurysm, but rather in relation to the left kidney, which also showed several simple cysts and angiomyolipomas. The patient remained stable and initial urgent surgical intervention was ruled out, while close vigilance was maintained.
Subramanian Senthilkumaran, Namasivayam Balamurgan, Shah Sweni, Ponniah Thirumalaikolundusubramanian
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.020
Published online: August 5 2010
xBeta-blockers or calcium channel blockers are major cardiovascular drugs. Both have similar physiologic and toxic effects, and act synergistically. These include refractory bradycardia, heart block, and hypotension. A compromised perfusion of the optic nerve head leads to ischemic optic neuropathy. Two cases of combined beta-blocker and calcium channel blocker overdose causing a previously unknown complication of posterior ischemic optic neuropathy are presented to create awareness so as to make an early recognition of the toxic etiologies, and to introduce appropriate therapy and minimize morbidity.
Abdelhalim El Ibrahimi, Mohammed Shimi, Mohammed Elidrissi, Abdelkrim Daoudi, Abdelmajid Elmrini
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.021
Published online: August 5 2010
xTotal dislocation of talus is a rare and serious injury. The course in most cases is dominated by osteonecrosis, which explains the poor prognosis of this condition. Authors report a case of closed total dislocation of talus in its anterolateral variety. Reduction of dislocation had been performed in emergency by external manipulation. At the last follow-up, the ankle was painless, stable with a satisfactory mobility, and without radiologic signs of necrosis.
Firat Bektas, Secgin Soyuncu
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.022
Published online: August 5 2010
xA 45-year-old man presented to the ED with a history of bruising rush on both his breast areas initiated 2 days ago and which increased rapidly. The vital signs and physical examination result of the patient were normal except for blue-black hemorrhagic and bruised lesions with a surrounding erythematous border on both his breast areas. Prothrombin and activated prothrombin time and international normalized ratio (1.2 [upper level is 1.2]), protein C, protein S, and antithrombine III levels and other laboratory parameters were also normal.
Sean Patrick Nordt, Jeffrey Zilberstein, Barry Gold
DOI: http://dx.doi.org/10.1016/j.ajem.2010.04.023
Published online: August 5 2010
xTorsade de pointes is a rare but life-threatening ventricular dysrhythmia that has been associated with numerous medications. We present a case of polymorphic ventricular tachycardia in a 55-year-old man on methadone. The patient's QTc interval normalized after discontinuation of the methadone. Emergency physicians should be aware of this potential adverse effect from methadone.
Philippe Gottignies, Jacques Devriendt, Emmanuel Tran Ngoc, Sébastien Roques, Arnaud Devriendt, Marie Vercruyssen, David De Bels
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.002
Published online: August 5 2010
xThromboembolic complications remain a frequent cause of morbidity and mortality in patients with a mechanical prosthetic heart valve. We report the case of a 57-year-old female patient admitted for acute respiratory distress. A thrombosis of the St Jude mitral valve was confirmed by transesophageal echocardiography. Surgery was planed, but brutal deterioration of her hemodynamic parameters and cardiac arrest prompted emergency thrombolysis. A LUCAS (Lund University Cardiopulmonary Assist System) chest compression device was used.
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00136-7
Published in issue: May 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00137-9
Published in issue: May 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00138-0
Published in issue: May 2011
DOI: http://dx.doi.org/10.1016/S0735-6757(11)00139-2
Published in issue: May 2011
